Leadless technology: a new paradigm for cardiac pacing?

Leadless pacemaker (LP) technology was recently developed and introduced for clinical purpose as an alternative to traditional systems in order to reduce leads and pocket-related complications. Currently, two self-contained right ventricular pacemakers implanted by using a femoral percutaneous approach have been developed and initial results seem promising. Although the clinical use is still limited to the right ventricular pacing, the LP currently represents a valid and alternative solution in several settings, when the standard pacemaker cannot be used or its use is associated with higher risk of complications. Implementation of particular pacing algorithms in the near future will allow for a VDD pacing mode with only a single ventricular component, whereas the next evolution of technology will lead to develop multicomponent, communicating leadless systems capable to perform a dual-chamber pacing or even a cardiac resynchronization. The management after battery depletion is still controversial and experience on retrievability is anecdotic. Long term data from registry are necessary to reinforce the reliability of these systems in the real life and randomized trials comparing LPs with traditional pacemaker will be essential to better understand if the LP can become a new paradigm in cardiac pacing.